On general principles, necrosed or de tached bone should be looked for in all cases. Strict antiseptic precautions are imperative to avoid mixed infection (bacilli of tuberculosis and pyogenic cocci). Preliminary precautions should be taken to meet violent haemorrhage due to vascular erosion.
When there is local inflammation and spontaneous opening of the abscess is probable, there should be a free incision, a thorough scraping of its walls with Volkmann's curette to transform the suppurating surfaces into bleeding ones. The cavity is then cleansed with a 5 per-cent. solution of carbolic acid, a long drain is applied, and the wound is stitched as far as the drain. An anti septic dressing is then applied. (Volk mann, Tirelat, Pozzi.) After opening the abscess the cavity may be washed out with peroxide of hydrogen in 10-per-cent. solution or packed with iodoform gauze. Removal of the limiting sac is then performed by decortication, the steps being: free incision, the sac detached with finger or spatula and removed, and the cavity closed immediately. (Lannelongue.) Peroxide of hydrogen is a prophylac tic and curative medicament in the treatment of suppurative skin lesions so common in infants. A twelve-volume solution is ample as a skin-wash twice daily. This rapidly cures superficial lesions. Abscesses must obviously be evacuated before the peroxide solution is used. Cochart (Jour. de Med. de Paris, April 21, 1901).
The removal of the limiting sac is facilitated by filling the wound with paraffin; the mass can then be removed as if it were a lipoma. (Cazin.) A psoas abscess should be opened in the loin and groin when possible. In the loin the incision should be made through the external and internal ob lique, transversalis, and lumbar fascia, along the outer edge of the erector spin to the edge of the quadrates lumborum. The latter muscle and the transversalis fascia are divided on a level with the tip of the second or third lumbar trans verse process, avoiding the lumbar ar teries. The sheath and the psoas are
then perforated with the finger or a trocar. A counter-opening is then made below Poupart's ligament to form a tunnel, into which a large-size drainage tube is inserted. This is replaced. late' on, by a tube at each end to obtain oblit eration, beginning from the centre of the canal. If one incision is preferred the loin should be selected.
Aspiration and Injeclions.—When no local inflammation indicates that the abscess is soon to open, the fluid may be withdrawn with a large aspirator; a 5-per-cent. solution of carbolic acid is injected and then aspirated. This pro cedure is renewed until the solution withdrawn is perfectly clear. A Lister bandage is then applied, insuring slight pressure. Five clays later the treatment is renewed. About five sittings are re quired. (Boeckel.) Injection fluids: Iodoform, 1 part; ether, 5 parts; distilled water, 5 parts. Injection not to be renewed while iodo form is being excreted in the urine. (Mosetig-Moorh of, Verneuil.) Less painful is a mixture of 1 part of iodoform to 10 of glycerin (Billroth) or of olive-oil (Bruns).
Intoxication may be prevented by sterilizing the iodoform and excipient (except ether) by heating at 212° F. separately. (Tillmann.) Boric acid, a 4-per-cent. solution, may be used as above (Menard), or naphthol and camphor, 1 part each. About thirty sittings are usually required.
The lesion being a tuberculous one, the general system should be treated ac cordingly. Nutritious food, including a free supply of milk and eggs, pure air, sunlight, and sea-air, if possible. are in dicated, as well as tonics and alteratives (codliver-oil and hypophosphites, iodine, iodides, arsenic, quinine, strychnine.
etc.). C. s MINER WITHERSTINE, Philadelphia.